Provider Demographics
NPI:1174415442
Name:BLUE MIST PSYCHOTHERAPY, PLLC
Entity type:Organization
Organization Name:BLUE MIST PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JULISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:610-841-6081
Mailing Address - Street 1:1864 TACOMA WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-1454
Mailing Address - Country:US
Mailing Address - Phone:704-480-3693
Mailing Address - Fax:704-703-6149
Practice Address - Street 1:1864 TACOMA WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-1454
Practice Address - Country:US
Practice Address - Phone:704-480-3693
Practice Address - Fax:704-703-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-19
Last Update Date:2025-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty